Head Injury

Question 0

What is the initial nursing care of a patient w/ head injury?

Answer 0

Airway control, resuscitation & admission to the ICU

Question 1

Explain “talk and die” syndrome

Answer 1

Present w/ GCS > 9-13
Initially talking and w/o significant signs of external injury
Rapidly deteriorate within 48 hours of injury
78-80% of cases from epidural haematoma
Have worse outcome than patients who present with TBI at onset

Question 2

What’s Cushing’s Triad?

Answer 2

Acute entity seen in severely head injured patients w/ significant increased ICP and impending herniation
Resulting from: ischaemia to hypothalamus w/ poor perfusion to brain
Results in: sympathetic stimulation of the heart to correct poor perfusion Characterised by: progressive hypertension, bradycardia, irregular or impaired respiratory pattern

Question 3

What is the recommended ICP?

Answer 3

< 20 mmHg

Question 4

What degree should the head of the bed be at for a pt w/ an increased ICP?

Answer 4

30 degrees

Question 5

Why are hypotonic fluids contraindicated to treat hypotension in a patient w/ a severe head injury?

Answer 5

?

Question 6

Why is mannitol administered for severe head injury and when is it contraindicated?

Answer 6

Because if it’s potent diuretic properties - quickly reduces ICP
Contraindicated in Pts w/ severe heart failure, renal disease, pulmonary congestion or oedema, active intracranial pressure, dehydration and disturbance of blood-brain barrier

Question 7

Explain secondary impact syndrome

Answer 7

Suffers a second head injury before the first injury has healed
1st injury: causes disruption of normal cerebral vascular autoregulation that causes increased cerebral blood flow
2nd injury: Pts develop rapid diffuse cerebral oedema (within 2mins), increased ICP and eventual herniation, coma and death

Question 8

Explain post concussive syndrome

Answer 8

Constellation of symptoms that develops within 4 weeks of injury + may persist for months

Question 9

Explain post-traumatic epilepsy

Answer 9

Seizure activity > 7 days from traumatic injury

Question 10

What age group is most likely to present to the ED with a head trauma?

Answer 10

15-24 yo

Question 11

What number on a GCS represents a MET call?

Answer 11

< 9

Question 12

Explain the Monroe-Kelli hypothesis

Answer 12

The expansion of one compartment MUST be accompanied by a compensatory reduction in the volumes of the other compartments to maintain a stable ICP

Question 13

What is a primary brain injury and give an example

Answer 13

Direct or indirect force to brain tissue resulting in cellular injury
E.g. Physical Trauma

Question 14

What is a secondary brain injury and give an example

Answer 14

Systemic or intracranial process that contributes to the primary brain injury cycle and results in. Greater tissue damage
E.g. Systemic insult and intracranial insults

Question 15

What is a systemic insult in relation to secondary brain injury

Answer 15

Hypoxia (PaO2 < 60mmHg), hypotension (SBP < 90mmHg), anaemia blood loss (dec O2 carrying capacity), hypo/hypercapnia (hyperventilation + vasoconstriction)
Seizures, electrolyte abnormalities, coagulopathy, infection, hyperthermia + iatrogenic

Question 16

What is an intracranial insult in relation to secondary brain injury?

Answer 16

Intracranial hypertension, extra-axial lesions, cerebral oedema (peaks at 24-48 hours post injury)

Question 17

Give examples of the mechanisms of injury for head trauma

Answer 17

Skull fracture, extra-axial lesions (extradural + subdural haematoma), intracranial haemorrhage, subarachnoid haemorrhage

Question 18

Where is an epidural haematoma located and what are the main manifestations?

Answer 18

Between skull and dura mater
Head injury w/ LOC + lucid interval followed by deterioration
Lenticular shape on CT

Question 19

What is a subdural haematoma located and what are the main manifestations?

Answer 19

Blood accumulation between dura mater and pia arachnoid mater
Increased risk in elderly + alcoholics due to dec brain volume
Hyper dense crescent shaped lesion

Question 20

What is the diagnostic test that will allow for the best prognosis of a head injury to be determined?

Answer 20

CT scan

Question 21

What are the routine diagnostic tests for a patient with a head injury and why?

Answer 21

Coagulation profile, FBC, U&Es, LFTs, ABGs, CT scan, MRI, x-ray

Question 22

What are we going to include in the clinical assessment of a pt w/ head trauma

Answer 22

MIVT (mechanism of injury, injuries sustained, vitals, treatment), hx of LOC, FNO, GCS, PEARL, vomiting/nausea

Question 23

What are the complications of head injury?

Answer 23

IICP causes brain herniation (Coning), secondary impact syndrome